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. 2019 Jan 15;16(1):e1002723.
doi: 10.1371/journal.pmed.1002723. eCollection 2019 Jan.

Rapid antiretroviral therapy initiation in low- and middle-income countries: A resource-based approach

Mark W Tenforde  1   2   3 , A Sarah Walker  4 , Diana M Gibb  4 , Yukari C Manabe  5   6
Affiliations

Rapid antiretroviral therapy initiation in low- and middle-income countries: A resource-based approach

Mark W Tenforde et al. PLoS Med. .

Abstract

In an Essay, Mark Tenforde and colleagues advocate continued provision of baseline CD4 cell count testing in HIV care in low- and middle-income countries.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: ASW and DMG declare that the REALITY trial which is referred to in this essay and which prompted interest in this area was funded by the Medical Research Council, UK, the Wellcome Trust, and the UK Department for International Development. Drugs were donated from Gilead Sciences, ViiV, Merck, and Cipla Ltd. ASW’s institution has received funding for ASW’s membership of a DSMB from Janssen and for teaching on courses on critical appraisal and cohort design management and analysis from Gilead Sciences. MWT has received US National Institutes of Health training grant support and has no competing interests to declare. YCM declares US National Institutes of Health and CDC grants to his institution to study point-of-care tests.

Figures

Fig 1
Fig 1. Resource-based approach for targeting OIs.
* If smear or Xpert MTB/RIF is negative or unable to perform but suspicion for TB is high, consider further evaluation and/or empiric 4-drug treatment. † Low-dose FLU 100 mg/day for 12 weeks used in REALITY trial, compared to FLU 800 mg/day for 10 weeks then 200 mg/day maintenance pending CD4 count recovery recommended by WHO for CrAg-positive adults. ‡ AZ if CD4 ≤ 100 following REALITY trial. ART, antiretroviral therapy; ATT, anti-TB therapy; AZ, azithromycin; CrAg, cryptococcal antigen; CTX, cotrimoxazole; FLU, fluconazole; ICF, intensified TB case finding; INH, isoniazid; LAM, lipoarabinomannan; OI, opportunistic infection; TB, tuberculosis; WHO, World Health Organization.
See this image and copyright information in PMC

References

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